Breast Cancer, Male

• • Painless lump beneath the areola in a man who is usually over the age of 50

  • Nipple discharge, retraction, or ulceration may be present

Epidemiology

• • Rare disease, with an incidence only about 1% of that for carcinoma of the female breast

  • Average age of occurrence is about 60 years

  • 75% of males with nipple discharge have a breast carcinoma

  • Increase risk with BrCA-2 mutation

Symptoms and Signs

• • Hard, painless breast lump, often beneath the areola

  • Nipple discharge, retraction, erosion, or ulceration

  • May have accompanying gynecomastia

Imaging Findings

• • Mass on mammography

• • Blood-borne metastases often present at initial presentation, although may be latent

Rule Out

• • Gynecomastia

  • Metastatic cancer from another site

• • History and physical exam

  • Mammography

  • Needle biopsy

• • Modified radical mastectomy is first-line therapy for surgical candidates

  • Surgical candidates chosen by the same criteria as women

  • Irradiation is the first step in treating localized metastases to skin, lymph nodes, or bone that are causing symptoms

  • Tumor hormone receptor status may be of benefit in determining role of adjuvant biochemotherapy

  • Castration is possible palliative measure for advanced metastatic disease

Medications

• • Tamoxifen for metastatic disease

  • Potential role of aminoglutethimide to suppress adrenal androgen production (has replaced adrenalectomy)

Prognosis

• • Worse prognosis, stage for stage, than female breast carcinoma

  • 5- and 10-year survival for stage I cancer is 58% and 38%, respectively

  • 5- and 10-year survival for stage II cancer is 38% and 10%, respectively

  • 5- and 10-year survival rates for all stages combined are 36% and 17%, respectively

References

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.nccn.org/